Healthcare Provider Details

I. General information

NPI: 1629042858
Provider Name (Legal Business Name): MEGAN G DESANTIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELLIOT WAY SUITE302
MANCHESTER NH
03103-3547
US

IV. Provider business mailing address

35 QUAIL CT
MANCHESTER NH
03109-5930
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-1887
  • Fax: 603-627-1890
Mailing address:
  • Phone: 603-232-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0462
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: